Other Shoulder Conditions

Shoulder impingement/Rotator cuff tendinosis

What is shoulder impingement?

Shoulder impingement is a common cause of shoulder pain. It occurs when the bones of the shoulder impinge on the muscles and tendons of the rotator cuff or thelubricating sac called a bursa.If the bursa becomes swollen and inflamed, this is called bursitis. If the rotator cuff tendons below the bursabecome inflamed, this is called tendinitis or tendinosis. Both of these are painful conditions.

Impingement is associated with repetitive overhead activity such as painting, tennis and swimming.

What are the symptoms of shoulder impingement?

Shoulder impingement and rotator cuff tendinitis tend to cause pain at the front and side of the shoulder and down the upper arm. Many people find that the pain is worse when lifting the arm above shoulder height, when lowering the arm from a position above the head and at night.

As the problem progresses, patients often describe frequent pain at night, loss of strength and motion and difficulty performing overhead activities and any movement above shoulder height.

What does your doctor look for?

After a careful discussion of symptoms, your doctor will check the range of motion of your shoulder, assess the power of your rotator cuff muscles and also assess which of the multiple sites within the shoulder may be causing pain.

What investigations are needed?

All patients are assessed with an X-ray and many patients have an ultrasound scan to assess the integrity of their rotator cuff.

If surgery is considered, an MRI scan is usually organised to further assess the rotator cuff damage and whether it is repairable.

How is shoulder impingement treated?

Shoulder impingement surgery

Most shoulders will make an improvement without surgery. But surgery may be recommended if non-surgical treatment does not relieve pain and restore full function.

The goal of surgery is to create more space for the rotator cuff. This is usually performed via arthroscopy (keyhole surgery) and commonly involves removing the bursa to create more space for the rotator cuff.Arthroscopic surgery allows a full assessment of the joint and if a rotator cuff tear is noted, it may also be repaired.

Our specialists at Orthopaedic Clinics Gold Coast will discuss whether this procedure is suitable for you at your visit.

Possible complications

The complications are generic to all shoulder procedures. They include infection, bleeding and damage to surrounding structures.

Calcific tendinitis

What is calcific tendinitis?

Calcific tendinitis refers to a build-up of calcium in the rotator cuff muscles and tendons. The calcium can cause pressure within the rotator cuff tissues as well as causing a chemical irritation. Why calcium builds up is not known. It does eventually disappear but this can take 5–10 years.

It seems to be more common in people between the ages of 30–60 years of age.

What are the symptoms of calcific tendinitis?

Calcific tendinitis can be very painful. In fact, it is one of the most painful shoulder conditions.The pain is due to both chemical irritation and increasedpressure, the latter of which results from calcium deposit taking up space between the rotator cuff and the bone above it.

Along with pain, people often experience a loss of normal shoulder function, especially when lifting the arm overhead.

What does your doctor look for?

Along with taking a history, your doctor will perform a physical examination, including a shoulder assessment. Most patients with calcific tendinitis have a markedly reduced range of motion with severe pain and tenderness of the shoulder.

What investigations are needed?

In many cases, the calcium deposits show up on X-ray. Your doctor may also organise an ultrasound scan to find small deposits that can be missed on X-ray. An ultrasound allows assessment of the size of the calcium deposit in all directions.

An MRI scan may be required to further assess the shoulder. Although, this is not typically the best way to fully visualise calcium deposits.

How is calcific tendinitis treated?

Treatment options for calcific tendinitis include:

non-drug therapy (eg physiotherapy to keep the shoulder strong and flexible while waiting for the condition to resolve)

medication (eg oral pain killers and anti-inflammatories; injections into the joint;ultrasound-guided ‘needling’ of the calcium deposit where the calcium is injected and then sucked out with a syringe)

surgery

Calcific tendinitis surgery

If the pain is not controlled with non-surgical therapy, or the pain is extremely severe, surgery may be required. The goal of surgery is to remove the calcium. It is usually done via arthroscopy (keyhole surgery) where the calcium deposit is viewed through the arthroscope and then localised with a needle. A small incision is made in the rotator cuff and the calcium is removed. The removed calcium often looks like toothpaste.

This may be a day procedure or may require a single night in hospital.

After surgery you will be encouraged to use your arm as much as you can, unless you have had another procedure at the same time (eg rotator cuff repair).

Our specialists at Orthopaedic Clinics Gold Coast will discuss whether this procedure is suitable for you at your visit.

Possible complications

The most common (~ 30%)complication is stiffness, which is sometimes referred to as Frozen shoulder. This occurs most frequently in patients with diabetes and in middle-aged women. If it does occur, it does not mean that further surgery is necessary. It just means the recovery may take a little longer.

Acromioclavicular (AC) joint arthritis

What is AC joint arthritis?

Arthritis refers to inflammation or degeneration of a joint. The acromioclavicular (AC) joint is the joint between the acromion and the clavicle on the top of the shoulder. These joint surfaces are usually lined by smooth cartilage. Damage to this cartilage can be progressive over time and may result from an injury to the shoulder, dislocation of the joint or possibly just from normal wear and tear.

AC joint arthritis is often associated with shoulder impingement or rotator cuff tear. It is common in weight lifters or people who perform frequent overhead activities

What are the symptoms of AC joint arthritis?

Pain of the AC joint is the most common symptom. The pain is typically worse when lifting the arm overhead. Additionally, there is often bony swelling on either side of the joint.

What does your doctor look for?

When examining the shoulder, your doctor will be looking for pain on palpation ofthe AC joint. The pain is often worse with deep pressure and when moving the arm across the body or moving the arm up over the head.

What investigations are needed?

AC joint arthritis or irritation is frequently diagnosed with a clinic examination. But an X-ray is still required to make a further assessment of the joint.

AC joint surgery

Surgical options for AC joint arthritis include:

arthroscopic debridement – which is keyhole surgery to remove damaged cartilage from the surfaces of the joint, and frequently, approximately 5mm of the clavicle bone and a small part of the surface of the acromion joint are removed too

open surgery – which is used where there is large bony swelling around the joint, and which consists of a 3cm incision over the top surface of the shoulder

Surgery is very successful for relieving pain and irritation at this site.Our specialists at Orthopaedic Clinics Gold Coast will discuss whether this procedure is suitable for you at your visit.

Possible complications

Most people are happy with the results of their surgery.But complications do occur occasionally. Complications related to this procedure are similar to all shoulder procedures (ie infection, bleeding and damage to surrounding structures) and there is a small chance that pain may not be completely resolved.

Frozen shoulder/Adhesive capsulitis

What is frozen shoulder?

Frozen shoulder (or Adhesive capsulitis) is a very painful condition of the shoulder where the shoulder becomes progressively more stiff and immovable. Normally, the shoulder is one of the most mobile joints of the body and this is because of the flexibility of its capsule (which is the lining of the joint).With a frozen shoulder, the capsule or lining of the joint becomes stiff from inflammation and contraction, and this causes progressive limitation of range of motion.

Frozen shoulder is associated conditions such as:

diabetes

high cholesterol

heart disease

previous injury to the shoulder

shoulder surgery

While frozen shoulder may occur after surgery or injury, it normally starts with no preceding incident.

What are the symptoms of frozen shoulder?

The condition usually goes through three phases:

Freezing phase – which involve dramatic pain (often worse at night) and progressive loss of range of motion. This stage usually lasts approximately 6–9 months

Frozen phase – where the painbeings to diminish but the stiffness of the shoulder remains. This often causes problems performing normal daily activities such as dressing or driving. This stage may last 6–9 months

Thawing phase – where the condition starts to resolve. This phase is reached by most people approximately 12–18 months after the onset of symptoms

What does your doctor look for?

Your doctor will assess the movement of your shoulder, checking flexion, abduction and external rotation. Problems moving the hand away from the body is characteristic of this condition.

In the early phases, the shoulder is often tender to palpate. In the frozen phase, the pain subsides and the shoulder becomes more comfortable (although patients are still limited in their ability to perform normal daily activities).

What investigations are needed?

The diagnosis can usually be made after examining your shoulder. But an X-ray is often needed to exclude other conditions that may mimic frozen shoulder such as shoulder osteoarthritis or possibly a dislocation of the shoulder.

An ultrasound scan is often used to assess the rotator cuff.

How is frozen shoulder treated?

Most shoulders will improve significantly without treatment 2–4 years after onset. Many people don’t want to wait this long and seek treatment.

Treatment options for frozen shoulder include:

non-drug therapy (eg physiotherapy to prevent further stiffness and regain range of motion)

medication (eg oral pain killers and anti-inflammatories; injections of corticosteroid or fluid into the joint)

surgery

Frozen shoulder surgery

If non-surgical treatments have been unsuccessful in improving your range of motion, surgery may be considered.

The most frequent surgery performed is an arthroscopic capsular release, which is often combined with a manipulation under anaesthetic. During the procedure, an arthroscope is used to visualise the shoulder joint and the capsule is then divided to dramatically improve range of motion. This is an excellent and highly successful procedure for both pain relief and restoring movement. Our specialists at Orthopaedic Clinics Gold Coast will discuss whether this procedure is suitable for you at your visit.

It is important to undergo extensive physiotherapy following the surgery to maintain range of motion.

Possible complications

Complications are generic to all shoulder procedures and include infection, bleeding and damage to surrounding structures.